Inspection on 05/07/06 for La Rosa

This inspection was carried out on 5th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

La Rosa 28/08/08

La Rosa 20/08/07

La Rosa 14/03/06

La Rosa 21/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 La Rosa 97 Babington Road Streatham London SW16 6AN Lead Inspector Sonia McKay & Vashti Maharaj Unannounced Inspection 5th July 2006 08:00 La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service La Rosa Address 97 Babington Road Streatham London SW16 6AN 020 7787 9694 020 8835 0981 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Parvadee Shumoogam Mr Radhakrisna Sookur Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2006 Brief Description of the Service: La Rosa is a private residential care home that provides 24-hour care and support for three adults with mental health needs. The home is situated in a residential area, close to high-street shopping and transport links. The home opened in September 2005. Fees range between £550.00 and £900.00 per week and vary according to the support needs of the individual. The home provides prospective service users with a written guide that provides information about the service. A copy of the most recent CSCI inspection report is available in the reception hallway. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in nine hours over one day. It involved talking with the acting home manager, the deputy home manager and all three of the service users. Records relating to individual care arrangements, staff recruitment and training and health and safety were examined and there was a tour of the premises. Local authority care managers involved in the placement of two of the service users provided feedback about the service provided by telephone. What the service does well: What has improved since the last inspection? There is better support for service user in the area of healthcare. Staff are keeping better records about healthcare appointments and they take swift action when changes in mental health are observed. There are clear plans for supporting new service users to get to know the local area and for registering with local healthcare services. Consideration has been given to a service users right to make decisions for himself. This has resulted in more support to manage his finances, and risk management strategies around maintaining good health. Prescribed medications are administered by trained staff and are safely stored. Staff no longer work for extended periods without a break and they can only work in the home if satisfactory checks have been made during recruitment. The newly appointed acting home manager is communicating a sense of direction and has clear plans for service improvement and providing greater opportunities for service users to develop their independent living skills. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have an opportunity to visit and test drive the service before making a decision to move in for a trial period. There is a need to increase the information that is provided to prospective service users in the service users guide and for more detailed contracts. Individual needs and aspirations are assessed. EVIDENCE: There is an informative statement of Purpose and a ‘service users’ guide’. However, contracts do not provide sufficient detail about client fee contributions towards placement costs and what these contributions cover. The information provided to service users must be revised in accordance with recent changes in the Care Homes Regulations of 2001 that are due to come into force in September 2006. The service users guide and associated individual contracts must be amended to provide greater detail relating to the standard package of services provided. The terms and conditions (including fee levels) that apply to key services (both personal care and food) and the payment arrangements (service user contribution/local authority contribution) must be stipulated. The guide must also state whether the terms and conditions (including fees) would be different La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 9 in circumstances where a service user’s care is funded, in whole or in part, by someone other than the service user (See recommendation 1) The statement of purpose and service users guide should also be reviewed to reflect recent staff changes. (See recommendation 2) The home provides long-term rehabilitative placements. There is opportunity for pre-admission visits and overnight stays. This allows the referred person to experience life in the home before making a positive choice to move in for a trial period. There is a thorough pre-admission needs assessment process. This involves obtaining the health and social services community care assessment and care plan and care programme approach (CPA) documents. The home carries out a comprehensive needs assessment and trial placement evaluation and requests additional assessment information from relevant mental health teams as required. Initial care plans and risk assessments are developed from this information. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessed and changing needs of service users are reflected in their individual care plans and risk assessments. Service users are encouraged and supported to make their own decisions, however, records relating to the support that one service user receives in regard to his financial matters are incomplete. EVIDENCE: Written plans for care are in place for each of the three service users and these plans include overall risk assessment audit tools and risk management and contingency plans. Evidence suggests that care plans and risk assessments are reviewed as the need arises. Each service user has a key worker and key worker/service user meetings are held regularly. There is a record of these meetings that includes a detailed monthly progress report. Both parties sign these notes. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 11 There are initial care plans for ensuring that new service users are swiftly linked to local health services and there are also plans that focus on rehabilitation and developing independent living skills. The written information held in individual care files is, in some cases, difficult to find. The acting home manager recognises the need to ensure that up to date information is readily available for staff and is in the process of rearranging the various care plans and risk assessments. Service users are able to make decisions about their lives where possible. Information is readily available about local advocacy services that can provide support if necessary. One service user needs considerable assistance in the area of managing his financial affairs. During the March 2006 inspection it was noted that the registered provider was providing the service user with cigarettes and personal items as he was refusing to withdraw his state benefits from his bank account. The home manager has recently been registered as the state benefit appointee, but as he is now on a period of extended leave it is not clear how this appointee-ship will be managed in his absence. There is a brief hand written record/statement of the payments made to the registered provider to cover recent placement fees/service user contributions. However, records of the bank account withdrawals examined suggest that although recent transactions are well documented, a bank withdrawal in April 2006 is not fully accounted for. This withdrawal may relate to the monies owing to the registered provider for the service users fee contribution and for items purchased on his behalf before the appointee-ship came into effect. This bank withdrawal and any related expenditure must be fully documented. (See requirements 1) The acting home manager ensures that detailed records are maintained for all more recent expenditures on personal items that are purchased by or on behalf of the service user and receipts are retained for each purchase. The registered person must ensure that records are kept of all incoming and outgoing payments made on behalf of this service user and these records should be independently audited and monitored. (See requirement 2 & recommendation 3) The service user is also spending more money on a weekly basis than his state benefits currently provide for. He is therefore using and reducing his savings on a weekly basis. The home manager should liase with the service users social worker to ascertain whether the service user is claiming the correct La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 12 amount of state benefits to cover his client contribution to placement and food costs and to retain a sufficient amount of disability benefit and personal spending money. (See recommendation 4) La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As the home opened only recently the service users have not lived in the area for long. There are plans in place to encourage and support increased community based activity, household activity and opportunities for leisure and personal development. These plans can be better enabled by the registered provider with provision of dedicated budgets for activities and food shopping. EVIDENCE: One service user living in the home has been able to continue with activities engaged in prior to entering the home. These activities include attending daytime social groups and skills development sessions at a daycentre. The service user is familiar with the local area and transport links. He visits members of his family on a regular basis and is being encouraged and supported by staff to re-establish other family links. All service users are registered on the electoral role. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 14 The other two service user have no structured daytime activities, although one is awaiting acceptance at a local daycentre that is able to provide a culturally appropriate service. The service user most recently admitted to the home enjoys visiting the local library on a regular basis. The acting home manager described the area orientation process for new service users. This involves a member of staff going out with all new service users to familiarise them with the local area, transport links, shops and leisure facilities. The manager also recognises the importance of supporting service users to develop relationships within the community and is introducing strategies to facilitate progress in this area. For example, assisting one service user to get to know local shopkeepers. Service users are able to maintain their personal relationships and friendships whilst living in the home, and can entertain their visitors in the privacy of their bedrooms if they wish. Service users like to spend some of their leisure time with staff, for example, engaged in in-house activities such as watching a movie and playing board or card games. The acting manager plans to introduce trips to the local cinema and bowling alley as a group activity supported by a member of staff. These social activities will be of benefit to service users who may not want to do things by themselves or who lack confidence. Service users are consulted about the choice of activities in regular house meetings. There is some progress in providing staff with a petty cash budget. This is of great benefit to key workers and the acting home manager and enables them to plan trips in advance. Staff previously spent their own money and were reimbursed later by the registered provider. A dedicated budget for activities is recommended. (See recommendation 5) Although there is a four-week rolling menu programme available, as there are only three service users in residence a daily choice of meals is prepared. Records are kept of these meals. The records show that a range of meals have been prepared, including culturally appropriate dishes. The service users are encouraged to assist staff to cook and service users said that they enjoy the meals provided. Food shopping is sometimes done in bulk by the registered proprietor. The acting home manager has introduced a cooking activity to encourage service users to become more involved and skilled in food shopping and cooking their own meals. A service user I like cooking with staff. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 15 It is recommended that service users be involved with shopping for all of the food and household provisions to develop their shopping and budgeting skills and to aid rehabilitation. (See recommendation 6). Each service user completes household chores to the best of their abilities. These include responsibilities for the care of their own bedrooms and the communal areas of the home. One service user is particularly keen to complete his cleaning duties but is not so keen on cooking. Responsibilities for the cleaning the communal areas are discussed and agreed in house meetings. Progress in assisting service user to develop more fulfilling lifestyles will be examined during the next inspection. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and require and their emotional and physical health needs are met. The administration of medication has improved although some areas must be fully addressed to ensure safe administration. EVIDENCE: There are detailed support plans for service users who require assistance with maintaining their personal hygiene. All assistance is provided in the privacy of bedrooms and bathrooms and is most often verbal prompting and helping to set baths and wash hair. A care manager commented that staff have successfully and sensitively supported and motivated a service user to improve his appearance and personal care in the short time he has lived at the home. All three service users are well dressed and groomed. Two of the service users require staff support to buy clothes and one service user is risk assessed as La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 17 needing to be monitored when going out in cold weather to ensure that he wears suitable clothing. Community attachment care plans are now in place. These plans identify healthcare needs and ensure that new service users register with appropriate local health services. These plans have been effective. Service users have all attended appointments with either the community mental health team (CMHT) or psychiatric teams attached to their placing authority. There is progress in ensuring referral to local community mental health teams for all service users. Service users have all visited the GP, either for a registration visit and check up or, in the case of a service user who has diabetes, for monitoring of blood sugar levels. All are registered with a dentist, optician and chiropodist. The outcomes of healthcare appointments are recorded well. Continence issues have been managed well, allowing service users more freedom and improved quality of life. Both local authority care managers contacted during this inspection are impressed by the support that service users have received in the area of healthcare and commented that the current staff team are pro-active in ensuring good multi-disciplinary working with health professionals. One service user is assessed as needing input from an occupational therapist in regard to assessment of the need for a specialist bed and chair to assist with his posture and breathing. The home has not yet arranged this referral. (See requirement 3) One service user is self-medicating. A risk assessment is in place in regard to self-medication. A lockable cabinet is available in the service users bedroom to store a weekly supply of tablets. Staff monitor compliance with medication in accordance with the written care plan. As a result of a recent period of mental ill health staff are providing additional support with medication. This is evidence of effective monitoring of changes and of taking appropriate action to support people when necessary. The other two service users require staff assistance to obtain and take medication. The hospital changed the medication regime for one service user this week, and the home manager has already written to both the pharmacy and the GP informing them of the change to ensure the change is implemented as soon as possible. Medication stocks are stored securely. All recording of receipts, returns and administration of medication carried out at the home are accurate. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 18 The recording of depot injections, which are administered to one service user fortnightly in hospital, is not always done. Although there are notes in the diary that indicate that the service user has attended the hospital for his injection, this entry must be made on the Medication Administration Record (MAR) chart also. (See requirement 4) Two inhalers have “use as directed” on the MAR chart instead of full instructions for use. The home must request that the GP puts full instructions on the prescription, and this must be added to the MAR chart by hand until the supplying pharmacy provides MAR charts with the full instructions for use. (See requirement 5) There are no home remedies (over the counter medications) in stock. This would be of use if a service user developed a headache or toothache during the night. Suitable over the counter items must be agreed by the GP to ensure that there are no contra-indications with prescribed medicines. (See requirement 6) There is progress in providing staff with information about possible side effects or the reasons that individual medications are prescribed. The acting home manager is in the process of updating medication profiles in language that is easily understood as patient information leaflets supplied are too technical. (See requirement 7) There is a medication policy that includes staff administration of medication and self-medication. The home now uses a different pharmacy to obtain medication supplies, and the manager has written a good guideline on the new system for ordering repeat prescriptions to ensure medication is always in stock. Staff who administer meds are either Registered Nurses, or are currently undertaking a Safe Handling of Medication course at a local college. One member of staff has not yet undergone medication training so is not on the authorised list of staff that can administer medication. Weight recordings for one service user were not accurate in the past, and were significantly lower than the actual weight. These records are now being recorded accurately. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted upon and they are protected from neglect and self-harm. Practices around ensuring service users are protected from financial abuse have improved but have not been followed on some occasions. EVIDENCE: There is a complaints procedure in place. The record of complaints shows that there have been no complaints made. One service user said he felt confident to raise any complaints or concerns with staff as they arise. There are regular opportunities for service users to discuss issues during regular key work and house meetings. Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing) to ensure the safety and protection of service users. There are adult protection procedures in place that include dealing with aggression and service users finances held in safekeeping. However, the procedures in regard to the safeguarding of the finances of one service user have not been followed on some occasions. (See requirements 1 & 2) Staff on duty on the day of the inspection demonstrated an understanding of possible reasons for aggressive behaviour and evidence suggests that they La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 20 have been pro-active in responding to issues of deteriorating mental health and self-care. The acting home manager is aware of the need to ensure that staff, awaiting full enhanced criminal record checks, are subject to satisfactory POVA first clearance before working in the home and the need for staff with only POVA first clearance to be supervised whilst working. There are a number of new staff. It is recommended that staff obtain and familiarise themselves with the local authority adult protection procedures, a copy of which should be retained in the home for reference. (See recommendation 7) La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, clean, safe and homely and current service users have bedrooms and communal areas that suit their needs. The rear garden must be cleared of building materials. EVIDENCE: The large home is clean, comfortably furnished and well decorated. All bedrooms are single occupancy and there is a choice of bedrooms available. The ground floor has a sitting room/office, a small staff office, a small kitchen, and a dining/sitting room with access to a back garden. The three service users currently residing in the home all smoke cigarettes and do so in the main lounge sitting area. Should a non-smoker move in to the home an alternative communal lounge must be available to avoid passive smoking. There are adequate toilet facilities and a small ground floor laundry area. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 22 The first floor has four bedrooms, three with en-suite facilities. There is also a bathroom. The second floor has three bedrooms, two with en-suite facilities and there is an additional bathroom with a shower unit. There is also a staff room. Two of the occupied bedrooms were seen during this inspection. Both bedrooms are well decorated and furnished with new beds and bedroom furniture, but they do not have all of the items listed in the national minimum standard, for example, lockable areas and a second comfortable chair. The acting home manager is consulting service users about this. (See recommendation 8) Both service users said that their bedrooms are comfortable and warm enough. Bathrooms and toilets are fitted with appropriate privacy locks and hot water is regulated to within safe temperature limits. The safety of unguarded radiators and hot central heating pipes must be assessed if any service user who experiences falls, epileptic seizures or blackouts of any sort is admitted to the home. (See recommendation 9) The rear garden is poorly maintained and there is building rubble and a discarded shopping trolley. (See requirement 8) There is no payphone, but service users have access to a cordless telephone handset if they wish. The LFEPA inspected the home in December 2005. Two requirements were issued and both have been addressed. A fire door has been fitted to the laundry room and a lock has been fitted to the door leading to the basement staircase. A recommendation was made for automatic door closure mechanisms to be fitted to doors to prevent them being wedged open. Although fire doors were not wedged open during this inspection, this action is recommended as a precaution. (See recommendation 10) La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. High staff turnover has impacted on continuity of care and progress with staff training and development. Recruitment practices have improved although records for all staff must be available. EVIDENCE: There is high staff turnover and this has affected staff continuity and staff training plans. The acting home manager is in the process of recruiting more support staff. There are currently five members of staff regularly working in the home. This includes the recently appointed acting home manager and deputy manager. The registered provider has also covered some shifts as a result of staff shortages. This is not ideal as role and lines of accountability are not clear. There are currently three permanent care staff. Staffing levels are between one and two. The supernumerary manager being available during the day achieves staffing levels of two. Staff do not work for extended periods without a break. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 24 A lone working policy is in place and the acting home manager provides an oncall support and advise service. The acting home manager is currently conducting a team training needs analysis. One member of the care team has attained an NVQ at level 2. Both managers are RMNs and both are undertaking the RMA. The following training has taken place: • Training in the safe administration of medication • The management of aggression and breakaway techniques • In house induction training is underway for newer members of staff and is ongoing. A training and development plan that encompasses the mandatory induction training, the national vocational training (NVQ) and the specific training required to enable staff to meet the specific needs of this group of service users, in accordance with the aims and objectives of the service, must be developed and supplied to the CSCI. (See requirement 9) All regular staff have satisfactory recruitment records and evidence of checks required by regulation is in place, including references, proof of identity and criminal records checks. On occasions bank staff have also covered shifts in the home. These are care staff who work in other care settings that the registered provider is involved with. Recruitment records and evidence of satisfactory checks are not available in the home. The acting home manager recognises the need to have access to a bank of staff for use in an emergency or to cover shifts when regular staff are unavailable. Full recruitment records and evidence of satisfactory checks must be available for all staff, inclusive of bank staff. (See requirement 10) Employment contracts stipulating contracted hours of employment and current roles within the home are not in place in some cases. (See requirement 11) La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recently appointed acting home manager has brought a sense of clear leadership to the home that was lacking at the previous inspection. The home managers are qualified and experienced and they must now develop the staff team and quality monitoring mechanisms to ensure that the service achieves its stated aims and objectives. Record keeping and fire safety must be improved to ensure compliance with regulation and the safety of service users. EVIDENCE: The registered home manager has relevant experience and qualifications (RMN/RGN/Dip/SW & CMS) and undertaking a registered managers award (RMA). La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 26 The registered manager began a period of extended leave in June 2006 and is not scheduled to return until October 2006. The newly acting home manager is currently managing the service. The acting manager is a qualified RMN with extensive supervisory experience and experience in providing rehabilitation services. Discussion with the manager suggests that she has good leadership and communications skills. Evidence gathered during the inspection suggests that she is well organised and has clear plans for developing this newly registered service. The deputy manager is also an RMN. Both managers were observed to interact well with service users. During the March 2006 inspection it was noted that the registered manager had not been present in the home in accordance with the records of the staff duty rosters supplied. A requirement was made and the registered provider agreed that systems would be in place to monitor the presence of staff and keep accurate records of whether staff duty rosters were actually worked as planned. Whilst there is a signing in book that provides evidence of staff working the planned rosters the registered manager has not signed in at any time since March 2006. This does not communicate a clear sense of leadership, or an open and transparent management style and is a failure to maintain records required by regulation. (See requirement 12) Although service users complete satisfaction questionnaires there are no clear quality assurance plans. There is no annual development plan for the home and the views of all stakeholders are not sought. (See requirement 13) Some areas of record keeping must be improved. (See requirements 1, 2, 4, 10 & 12) Staff training records are incomplete and it in unclear whether staff have received certified training in: • Safe moving and handling • Fire safety • First Aid • Food hygiene • Infection control (See requirement 9) A metal container labelled as woodworm killer was found in the garden. The acting home manager disposed of it immediately, but care must be taken to ensure that dangerous chemicals are stored safely at all times. (See requirement 14) La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 27 An accident and incident record are available. There are no injuries recorded in the accident book and the CSCI and the placing authorities have been notified of incidents as required. Environmental health and safety and fire risk assessments are in place. Fire evacuation procedures and a building floor plan are displayed. Fire detection equipment is tested each week, and the fire fighting and detection equipment is also professionally tested on a regular basis. A record of fire evacuation drills could not be located and there is no evidence of drills having taken place. This is dangerous to service users and staff. (See requirement 15) Building and equipment safety certificates seen show that: • The gas appliances were tested on 18/05/05 • The mains electrical system was tested on 08/05/05 The registered provider confirmed that small electrical appliances were safety tested in April 2006. Records are kept of fridge and freezer temperatures and hot water temperatures and the results show that temperatures are maintained to within safe limits. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 X STAFFING Standard No Score 31 2 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 2 2 X 2 2 X La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 YA41 Regulation 17(2) Sch 4(8) Requirement Timescale for action 31/07/06 2. YA7 YA41 17(2) Sch 4(9)(a) 3. YA19 YA29 13(1) 12(1) 4. YA20 YA41 17(1) Sch 3(3)(j) The registered person must ensure that detailed records are kept of all care homes charges, and any amount paid by, or in respect of any service user and payments made by service users and of any transactions made on their behalf. The registered persons must 31/07/06 ensure that accurate and detailed records are maintained, and available for inspection, of all financial transactions made on behalf of any service user and of any valuables held in safe keeping by staff. Previous timescale of 28/04/06 not met. The registered person must 31/08/06 ensure that a referral is made to an occupational therapist in regard to one service user who may need a specialist chair and bed. The registered person must 31/07/06 ensure that a record is kept of the administration of any DS0000065081.V302521.R01.S.doc Version 5.2 Page 30 La Rosa 5. YA20 13(2) 6. YA20 12(1) 13(2) 7. YA20 12(1) 13(2) 13(4) 8. YA24 23 9. YA35 YA32 YA42 18(1) medication administered at places other than at the home. For example, depot injections. The registered person must ensure that there are full instructions for the use of all prescribed medications, including items such as inhalers. The registered persons must ensure that advice is sought from the GP in regard to appropriate ‘homely remedy’ medicines for each service user. Evidence of agreed medicines and their administration must be maintained in medication records. Previous timescale of 19/05/06 not met. The registered persons must ensure medication profiles are updated for all service users to include potential side effects in order to effectively monitor any changes in condition of a resident which may be due to medication and should include when required PRN medication also. Although there is progress the previous timescale of 19/05/06 is not fully met. The registered person must ensure that the rear garden is cleared of building materials and discarded shopping trolley. The registered persons must ensure that there is a staff training and development programme that meets the Sector Skills Council workforce training targets DS0000065081.V302521.R01.S.doc 31/07/06 31/08/06 31/08/06 31/08/06 31/08/06 La Rosa Version 5.2 Page 31 10. YA34 YA41 19 17 11. YA34 12(5)(a) 12. YA41 YA38 17(2)Sch 4(7) 13. YA39 24 14. YA42 12 13 15. YA42 12 23 for mandatory training, NVQ requirements and the aims and objectives of the service. This programme must be supplied to the CSCI Southwark office. The registered persons must ensure that evidence of satisfactory recruitment checks are available on premises for all staff (Including bank staff). The registered persons must ensure that staff have written contracts and statements of terms and conditions of employment. This must include the number of hours that they are contracted to work. Previous timescale of 30/06/06 not met. The registered persons must ensure that a duty roster is kept of all staff working in the home (including the home manager) and a record of whether the roster was actually worked. Previous timescale of 14/04/06 not met. The registered persons must ensure that there are effective quality assurance and quality monitoring systems, based on seeking the views of service users, in place to measure success in achieving the aims, objectives and statement of purpose of the home. The registered person must ensure that substances hazardous to health (COSHH) are stored safely at all times. The registered persons must ensure that fire evacuation 31/07/06 31/08/06 31/07/06 31/10/06 31/07/06 31/07/06 La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 32 drills are conducted with the required frequency and the outcomes of these drills recorded. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 YA5 Good Practice Recommendations The registered persons should revise the service users guide and service user contracts to ensure that the additional information required by changes in legislation (coming into force on 1st September 2006) are added. The registered person should revise the statement of purpose and service users guide to reflect recent staff changes. The registered person should ensure that where a member of staff is a state benefit appointee for a service user, the records relating to all incoming and outgoing expenditures are independently audited and monitored. The registered person should liase with a placing authority to ascertain whether benefits claimed by one service user, who needs assistance to manage his finances, are sufficient to pay for his client contribution to rent and food and to retain a sufficient amount of personal allowance and disability benefit. The registered persons should provide an activities/petty cash system to cover staff activities costs and the cost of providing in house activities. The registered persons should involve service users in shopping for food provisions to promote and develop independent living skills. The registered persons should obtain a copy of the local authority adult protection procedures and ensure that staff are familiar with them. The registered person should ensure that service users bedrooms contain all items listed in national minimum standard 26.2. Where a service user expressly refuses a particular item a record of this decision should be kept in the persons individual plan. The registered persons must assess the safety of radiators and hot pipe-work if any service is admitted who DS0000065081.V302521.R01.S.doc Version 5.2 Page 33 2. 3. YA1 YA7 4. YA7 YA12 5. 6. 7. 8. YA14 YA13 YA12 YA17 YA23 YA26 9. La Rosa YA24 experiences falls or seizures. Appropriate remedial action should be taken in this event. 10. YA24 The registered persons should fit automatic door closure mechanisms that allow fire doors to be held open safely to prevent fire doors from being wedged open. La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI La Rosa DS0000065081.V302521.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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